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House lawmakers who hold the Pentagon’s purse strings berated the Defense Department on Thursday for failing to develop a joint electronic medical records system with the Veterans Affairs Department — an effort that has cost more than $1 billion since 2008 while producing scant results.
The 2008 Defense Authorization Act ordered DoD and VA to create a joint system for health records that would seamlessly follow troops throughout their lives, starting with boot camp and proceeding through separation from service and potential treatment by VA and civilian providers.
But last year, the two departments abandoned that initiative, originally estimated to cost $28 billion, in favor of a less expensive system based on existing technology that would coordinate communication between each other’s records as well as those in civilian hospitals.
But while DoD and VA can now view digital medical files at major VA polytrauma facilities and some DoD medical centers, as well as exchange real-time data on a limited basis, efforts toward a completely interoperable system have proceeded slowly.
“It’s enormously frustrating. It makes us angry. ... This is way beyond the claims backup VA has. It’s pretty damn important,” said Rep. Rodney Frelinghuysen, R-N.J., chairman of the House Appropriations Committee’s defense panel.
“We fought a world war in four years. We’re talking interoperability of electronic medical records from 2008 to 2017, and I’m appalled,” said Rep. Pete Visclosky, D-Ind., the panel’s senior Democrat.
Dr. Jonathan Woodson, assistant secretary of defense for health affairs, said the current coordination effort is akin to technology for cellphones, which comes from different manufacturers and operates on separate systems but “all talk to each other.”
The key, Woodson said, is figuring out the standardized way of handling the data — a problem being worked by DoD, VA and the Health and Human Services Department.
“This is a national problem,” Woodson said. “It’s exactly why we have taken the task of working it with the commercial market.”
The Pentagon has issued two contract solicitations for its future health records system, which is scheduled to have initial operating capability by 2017 and full capability by 2023. The estimated cost just for DoD’s portion of the system is $11 billion.
VA uses the Veterans Health Information Systems and Technology Architecture, or VistA, and has made its code available to commercial developers for public use. It has pressed DoD to use that system, but defense officials have balked.
VA Secretary Eric Shinseki said in March that he wants VistA to be among the systems competing for the DoD records system contract. Since VistA’s code is available for commercial use, an outside company could pitch a proposal to DoD based on VA’s software.
DoD’s $496 billion fiscal 2015 budget includes $47.4 billion for health care, including $9.2 million for data interoperability with VA and other health care providers.
In addition to concerns over electronic medical records, House appropriators quizzed the service surgeons general and Woodson about the Pentagon’s proposed overhaul of the Tricare system.
The Pentagon proposal would combine the three major existing Tricare plans — Prime, Standard and Extra — into a single system with a fee structure based on where beneficiaries get their medical care.
Panel members expressed concerns about whether the proposal goes far enough to save money — Rep. Jim Moran, D-Va., for example, asked why the plan would not require working-age retirees to pay more for their health care — while others, including Visclosky, expressed concern about an increased cost burden on junior enlisted families.
But ultimately, the panel did not present a united opinion on the Tricare fee issue.
After the hearing, Frelinghuysen said the Tricare proposals first must be reviewed by the House Armed Services Committee, which drafts the annual defense authorization bill. “We’ll look to them to see what markers they put down on the issue,” he said.
Staff writer Leo Shane contributed to this report.